| NPI | 1093919417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV SZ-127) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12476) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV 6227) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 55354) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2020-03-19 |